Shall We Skype?

“Hi, it’s me,” I hear as I listen to my voicemails between sessions. My stomach lurches; it’s Boyfriend. Though it’s been three months since we’ve spoken, his voice instantly transports me back in time, like hearing a song from the past. But as the message continues, I realize it’s not Boyfriend because (a) Boyfriend wouldn’t call my office number and (b) Boyfriend doesn’t work on a TV show.

This “me” is John (eerily, Boyfriend and John have similar voices, deep and low) and it’s the first time a patient has called my office without leaving a name. He does this as if he’s the only patient I have, not to mention the only “me” in my life. Even suicidal patients will leave their names. I’ve never gotten Hi, it’s me. You told me to call if I was feeling like killing myself.

John says in his message that he can’t make our session today because he’s stuck at the studio, so he’ll be Skyping in instead. He gives me his Skype handle, then says, “Talk to you at three.”

I note that he doesn’t ask if we can Skype or inquire whether I do Skype sessions in the first place. He just assumes it will happen because that’s how the world works for him. And while I’ll Skype with patients under certain circumstances, I think it’s a bad idea with John. So much of what I’m doing to help him relies on our in-the-room interaction. Say what you will about the wonders of technology, but

screen-to-screen is, as a colleague once said, “like doing therapy with a condom on.”

screen-to-screen is, as a colleague once said, “like doing therapy with a condom on.”

It’s not just the words people say or even the visual cues that therapists notice in person--the foot that shakes, the subtle facial twitch, the quivering lower lip, the eyes narrowing in anger. Beyond hearing and seeing, there’s something less tangible but equally important— the energy in the room, the being together. You lose that ineffable dimension when you aren’t sharing the same physical space.

There’s also the issue of glitches. I was once on a Skype session with a patient who was in Asia temporarily, and just as she began crying hysterically, the volume went out. All I saw was her mouth moving, but she didn’t know that I couldn’t hear what she was saying. Before I could get that across, the connection dropped entirely. It took ten minutes to restore the Skype, and by then not only was the moment lost but our time had run out.

I send John a quick email offering to reschedule, but he types back a message that reads like a modern-day telegram: Can’t w8. Urgent. Please. I’m surprised by the please and even more by his acknowledgment of needing urgent help--of needing me, rather than treating me as dispensable. So, I say okay, we’ll Skype at three.

Something, I figure, must be up.

At three, I open Skype and click “call,” expecting to find John sitting in an office at a desk. Instead, the call connects and I’m looking into a familiar house. It’s familiar to me because it’s one of the main sets of a TV show that Boyfriend and I used to binge-watch on my sofa, arms and legs entwined. Here, camera and lighting people are moving about, and I’m staring at the interior of a bedroom I’ve seen a million times. John’s face comes into view. “Hang on a second” is how he greets me, and then his face disappears and I’m looking at his feet. Today he’s wearing trendy checkered sneakers, and he seems to be walking somewhere while carrying me with him. Presumably he’s looking for privacy. Along with his shoes, I see thick electrical wires on the floor and hear a commotion in the background. Then John’s face reappears.

“Okay,” he says. “I’m ready.”

There’s a wall behind him now, and he starts rapid-fire whispering.

“It’s Margo and her idiot therapist. I don’t know how this person has a license but he’s making things worse, not better. She was supposed to be getting help for her depression but instead she’s getting more upset with me: I’m not available, I’m not listening, I’m distant, I avoid her, I forgot something on the calendar. Did I tell you that she created a shared Google calendar to make sure I won’t forget things that are ‘important’”—with his free hand, John does an air quote as he says the word important—“so now I’m even more stressed because my calendar is filled with Margo’s things and I’ve already got a packed schedule!”

John has gone over this with me before so I’m not sure what the urgency is about today. Initially he had lobbied Margo to see a therapist (“So she can complain to him”) but once she started going,

John often told me that this “idiot therapist” was “brainwashing” his wife and “putting crazy ideas in her head.”

John often told me that this “idiot therapist” was “brainwashing” his wife and “putting crazy ideas in her head.” My sense has been that the therapist is helping Margo gain more clarity about what she will and will not put up with and that this exploration has been long overdue. I mean, it can’t be easy being married to John.

At the same time, I empathize with John because his reaction is common. Whenever one person in a family system starts to make changes, even if the changes are healthy and positive, it’s not unusual for other members in the system to do everything they can to maintain the status quo and bring things back to homeostasis. If an addict stops drinking, for instance, family members often unconsciously sabotage that person’s recovery, because in order to regain homeostasis in the system, somebody has to fill the role of the troubled person. And who wants that role? Sometimes people even resist positive changes in their friends: Why are you going to the gym so much? Why can’t you stay out late—you don’t need more sleep! Why are you working so hard for that promotion? You’re no fun anymore!

If John’s wife becomes less depressed, how can John keep his role as the sane one in the couple? If she tries to get close in healthier ways, how can he preserve the comfortable distance he has so masterfully managed all of these years? I’m not surprised that John is having a negative reaction to Margo’s therapy. Her therapist seems to be doing a good job.

“So,” John continues, “last night, Margo asks me to come to bed, and I tell her I’ll be there in a minute, I have to answer a few emails. Normally after about two minutes she’ll be all over me—Why aren’t you coming to bed? Why are you always working? But last night, she doesn’t do any of that. And I’m amazed! I think, Jesus Christ, something’s finally working in her therapy, because she’s realizing that nagging me about coming to bed isn’t going to get me in bed any faster. So, I finish my emails, but when I get in bed, Margo’s asleep. Anyway, this morning, when we wake up, Margo says, ‘I’m glad you got your work done, but I miss you. I miss you a lot. I just want you to know that I miss you.’”

John turns to his left and now I hear what he hears—a nearby conversation about lighting—and without his saying a word, I’m staring at John’s sneakers again as they move across the floor. When I see his face appear this time, the wall behind him is gone, and now the star of the TV series is in the distant background in the upper-right corner of my screen, laughing with his on-camera nemesis along with the love interest he verbally abuses on the show. (I’m sure John is the one who writes this character).

I love these actors, so now I’m squinting at the three of them through my screen like I’m one of those people behind the ropes at the Emmys trying to get a glimpse of a celebrity—except this isn’t the red carpet and I’m watching them take sips from water bottles while they chat between scenes. The paparazzi would kill for this view, I think, and it takes massive will-power to focus solely on John.

“Anyway,” he whispers, “I knew it was too good to be true. I thought she was being understanding last night, but of course the complaining starts up again first thing this morning. So I say, ‘You miss me? What kind of guilt trip is that?’ I mean, I’m right here. I’m here every night. I’m one hundred percent loyal. Never cheated, never will. I provide a nice living. I’m an involved father. I even take care of the dog because Margo says she hates walking around with plastic bags of poop. And when I’m not there, I’m working. It’s not like I’m off in Cabo all day. So, I tell her I can quit my job and she can miss me less because I’ll be twiddling my thumbs at home, or I can keep my job and we’ll have a roof over our heads.” He yells “I’ll just be a minute!” to someone I can’t see and then continues. “And you know what she does when I say this? She says, all Oprah-like”—here he does a dead-on impression of Oprah—“‘I know you do a lot, and I appreciate that, but I also miss you even when you’re here.’”

I try to speak but John plows on. I haven’t seen him this stirred up before.

“So, for a second I’m relieved, because normally she’d yell at this point, but then I realize what’s going on. This sounds nothing like Margo. She’s up to something! And sure enough, she says, ‘I really need you to hear this.’ And I say, ‘I hear it, okay? I’m not deaf. I’ll try to come to bed earlier but I have to get my work done first.’ But then she gets this sad look on her face, like she’s about to cry, and it kills me when she gets that look, because I don’t want to make her sad. The last thing I want to do is disappoint her. But before I can say anything, she says, ‘I need you to hear how much I miss you because if you don’t hear it, I don’t know how much longer I can keep telling you.’ So I say, ‘We’re threatening each other now?’ and she says, ‘It’s not a threat, it’s the truth.’” John’s eyes become saucers and his free hand juts into the air, palm up, as if to say, can you believe this shit?

“I don’t think she’d actually do it,” he goes on, “but it shocked me because neither of us has ever threatened to leave before. When we got married we always said that no matter how angry we got, we would never threaten to leave, and in twelve years, we haven’t.” He looks to his right. “Okay, Tommy, let me take a look—.”

John stops talking and suddenly I’m staring at his sneakers again. When he finishes with Tommy, he starts walking somewhere. A minute later his face pops up; he’s in front of another wall.

My Idiot Therapist?

“John,” I say. “Let’s take a step back. First, I know you’re upset by what Margo said —.”

“What Margo said? It’s not even her! It’s her idiot therapist acting as her ventriloquist! She loves this guy. She quotes him all the time, like he’s her fucking guru. He probably serves Kool-Aid in the waiting room, and women all over the city are divorcing their husbands because they’re drinking this guy’s bullshit! I looked him up just to see what his credentials are and, sure enough, some moron therapy board gave him a license. Wendell Bronson, P-h-fucking-D.”

Wait.
Wendell Bronson?
!
!!
!!!!
!!!!!!!

Margo is seeing my Wendell? The “idiot therapist” is Wendell? My mind explodes. I wonder where on the couch Margo chose to sit on her first day. I wonder if Wendell tosses her tissue boxes or if she sits close enough to reach them herself. I wonder if we’ve ever passed each other on the way in or out (the pretty crying woman from the waiting room?). I wonder if she’s ever mentioned my name in her own therapy— “John has this awful therapist, Lori Gottlieb, who said . . .” But then I remember that John is keeping his therapy a secret from Margo—I’m the “hooker” he pays in cash—and right now, I’m tremendously grateful for this circumstance. I don’t know what to do with this information, so I do what therapists are taught to do when we’re having a complicated reaction to something and need more time to understand it. I do nothing—for the moment. I’ll get consultation on this later.

“Let’s stay with Margo for a second,” I say, as much to myself as to John. “I think what she said was sweet. She must really love you.”

“Huh? She’s threatening to leave!”

“Well, let’s look at it another way,” I say. “We’ve talked before about how there’s a difference between a criticism and a complaint, how the former contains judgment while the latter contains a request. But a complaint can also be an unvoiced compliment. I know that what Margo says often feels like a series of complaints. And they are—but they’re sweet complaints because inside each complaint, she’s giving you a compliment. The presentation isn’t optimal, but she’s saying that she loves you. She wants more of you. She misses you. She’s asking you to come closer. And now she’s saying that the experience of wanting to be with you and not having that reciprocated is so painful that she might not be able to tolerate it because she loves you so much.” I wait to let him absorb that last part. “That’s quite a compliment.”

I’m always working with John on identifying his in-the-moment feelings, because feelings lead to behaviors. Once we know what we’re feeling, we can make choices about where we want to go with them. But if we push them away the second they appear, often we end up veering off in the wrong direction, getting lost yet again in the land of chaos.

Men tend to be at a disadvantage here because they aren’t typically raised to have a working knowledge of their internal worlds; it’s less socially acceptable for men to talk about their feelings. While women feel cultural pressure to keep up their physical appearance, men feel that pressure to keep up their emotional appearance. Women tend to confide in friends or family members, but when men tell me how they feel in therapy, I’m almost always the first person they’ve said it to. Like my female patients, men struggle with marriage, self-esteem, identity, success, their parents, their childhoods, being loved and understood—and yet these topics can be tricky to bring up in any meaningful way with their male friends. It’s no wonder that the rates of substance abuse and suicide in middle-aged men continue to increase. Many men don’t feel they have any other place to turn.

So, I let John take his time to sort out his feelings about Margo’s “threat” and the softer message that might be behind it. I haven’t seen him sit with his feelings this long before, and I’m impressed that he’s able to do so now. John’s eyes have darted down and to the side, which is what usually happens with someone when what I’m saying touches someplace vulnerable, and I’m glad. It’s impossible to grow without first becoming vulnerable. It looks like he’s still really taking this in, that for the first time, his impact on Margo is resonating.

Finally, John looks back up at me. “Hi, sorry, I had to mute you back there. They were taping. I missed that. What were you saying?” Un-fucking-believable. I’ve been, quite literally, talking to myself. No wonder Margo wants to leave! I should have listened to my gut and had John reschedule an in-person session, but I got sucked in by his urgent plea.

Un-fucking-believable. I’ve been, quite literally, talking to myself

“John,” I say, “I really want to help you with this, but I think this is too important to talk about on Skype. Let’s schedule a time for you to come in so there aren’t so many distract —”

“Oh, no, no, no, no, no,” he interrupts. “This can’t wait. I just had to give you the background first so you can talk to him.”

“To . . .”

“The idiot therapist! Clearly he’s only hearing one side of the story, and not a very accurate side at that. But you know me. You can vouch for me. You can give this guy some perspective before Margo really goes nuts.”

I Won’t Do It!

I noodle this scenario around in my head: John wants me to call my own therapist to discuss why my patient isn’t happy with the therapy my therapist is doing with my patient’s wife.

Um, no.

Even if Wendell weren’t my therapist, I wouldn’t make this call. Sometimes, I’ll call another therapist to discuss a patient if, say, I’m seeing a couple and a colleague is seeing one member of the couple, and there’s a compelling reason to exchange information (somebody is suicidal or potentially violent, or we’re working on something in one setting that it would be helpful to have reinforced in another, or we want to get a broader perspective). But on these rare occasions, the parties will have signed releases to this effect. Wendell or no Wendell, I can’t call up the therapist of my patient’s wife for no clinically relevant reason and without both patients signing consent forms.

John wants me to call my own therapist to discuss why my patient isn’t happy with the therapy my therapist is doing with my patient’s wife

“Let me ask you something,” I say to John. “What?”

“Do you miss Margo?”

“Do I miss her?”

“Yes.”

“You’re not going to call Margo’s therapist, are you?”

“I’m not, and you’re not going to tell me how you really feel about Margo, are you?” I have a feeling that there’s a lot of buried love between John and Margo because I know this; love can often look like so many things that don’t seem like love.

John smiles as I see somebody who I assume is Tommy again enter the frame holding a script. I’m flipped toward the ground with such speed that I get dizzy, as if I’m on a roller coaster that just took a quick dive. Staring at John’s shoes, I hear some back-and-forth about whether the character—my favorite!—is supposed to be a complete asshole in this scene or maybe have some awareness that he’s being an asshole (interestingly, John picks awareness) and then Tommy thanks John and leaves. To my amusement, John seems perfectly pleasant, apologizing to Tommy for his absence and explaining to him that he’s busy “putting out a fire with the network.” (I’m “the network”). Maybe he’s polite to his coworkers after all.

Or maybe not. He waits for Tommy to leave, then lifts me up to face level again and mouths, Idiot, rolling his eyes in Tommy’s direction.

“I just don’t understand how her therapist, who’s a guy, can’t see both sides of this,” he continues. “Even you can see both sides of this!”

Even me? I smile. “Was that a compliment you just gave me?”

“No offense. I just meant...you know.”

I do know, but I want him to say it.

In his own way, he’s becoming attached to me

In his own way, he’s becoming attached to me, and I want him to stay in his emotional world a bit longer. But John goes back to his tirade about Margo pulling the wool over her therapist’s eyes and how Wendell is a quack because his sessions are only forty-five minutes, not the typical fifty. (This bugs me too, by the way). It occurs to me that John is talking about Wendell the way a husband might talk about a man his wife has a crush on. I think he’s jealous and feels left out of whatever goes on between Margo and Wendell in that room. (I’m jealous too! Does Wendell laugh at Margo’s jokes? Does he like her better?) I want to bring John back to that moment when he almost connected with me.

“I’m glad that you feel understood by me,” I say. John gets a deer-in-the-headlights look on his face for a second, then moves on.

“All I want to know is how to deal with Margo.”

“She already told you,” I say. “She misses you. I can see from our experience together how skilled you are at pushing away people who care about you. I’m not leaving, but Margo’s saying she might. So maybe you’ll try something different with her. Maybe you’ll let her know that you miss her too.” I pause. “Because I might be wrong, but I think you do miss her.”

He shrugs, and this time when he looks down, I’m not on mute. “I miss the way we were,” he says.

His expression is sad instead of angry now. Anger is the go-to feeling for most people because it’s outward-directed—angrily blaming others can feel deliciously sanctimonious. But often it’s only the tip of the iceberg, and if you look beneath the surface, you’ll glimpse submerged feelings you either weren’t aware of or didn’t want to show—fear, helplessness, envy, loneliness, insecurity. And if you can tolerate these deeper feelings long enough to understand them and listen to what they’re telling you, you’ll not only manage your anger in more productive ways, you also won’t be so angry all the time.

Of course, anger serves another function—it pushes people away and keeps them from getting close enough to see you. I wonder if John needs people to be angry at him so that they won’t see his sadness.

I start to speak, but somebody yells John’s name, startling him. The phone slips out of his hand and careens toward the floor, but just as I feel like my face might hit the ground, John catches it, bringing himself back into view. “Crap--gotta go!” he says. Then, under his breath: “Fucking morons.” And the screen goes blank.

Apparently, our session is over.

Ethics Over Coffee

With time to spare before my next session, I head into the kitchen for a snack. Two of my colleagues are there. Hillary is making tea. Mike’s eating a sandwich.

“Hypothetically,” I say, “what would you do if your patient’s wife was seeing your therapist, and your patient thought your therapist was an idiot?”

They look up at me, eyebrows raised. Hypotheticals in this kitchen are never hypothetical.

“No, really,” I say. “What would you do? It gets worse: He wants me to talk to my therapist about his wife. His wife doesn’t know he’s in therapy yet, so it’s a non-issue now, but what if at some point he tells her and then wants me to consult with my therapist about his wife, and his wife consents? Do I have to disclose that he’s my therapist?”

“Absolutely,” Hillary says.

“Not necessarily,” Mike says at the same time.

“Exactly,” I say. “It’s not clear. And you know why it’s not clear? Because this kind of thing NEVER HAPPENS! When has something like this ever happened?”

Hillary pours me some tea.

“I once had two people come to me individually for therapy right after they’d separated,” Mike says. “They had different last names and listed different addresses because of the separation, so I didn’t know they were married until the second session with each of them, when I realized I was hearing the same stories from different sides. Their mutual friend, who was a former patient, gave both of them my name. I had to refer them out.”

“Yeah,” I say, “but this isn’t two patients with a conflict of interest. My therapist is mixed up in this. What are the odds of that?”

I notice Hillary looking away. “What?” I say.

“Nothing.”

Mike looks at her. She blushes. “Spill it,” he says.

Hillary sighs. “Okay. About twenty years ago, when I was first starting out, I was seeing a young guy for depression. I felt like we were making progress, but then the therapy seemed to stall. I thought he wasn’t ready to move forward, but really I just didn’t have enough experience and was too green to know the difference. Anyway, he left, and about a year later, I ran into him at my therapist’s.”

Mike grins. “Your patient left you for your own therapist?”

Hillary nods. “The funny thing is, in therapy, I talked about how stuck I was with this patient and how helpless I felt when he left. I’m sure the patient later told my therapist about his inept former therapist and used my name at some point. My therapist had to have put two and two together.” I think about this in relation to the Wendell situation. “But your therapist never said anything?”

“Never,” Hillary says. “So, one day I brought it up. But of course, she can’t say that she sees this guy, so we kept the conversation focused on how I deal with the insecurities of being a new therapist. Pfft. My feelings? Whatever. I was just dying to know how their therapy was going and what she did differently with him that worked better.”

One by one, the green lights on the kitchen’s master panel go on, and we file out to retrieve our patients

They both shrug. Mike glances at the clock, tosses his trash into the can. Hillary and I take our last sips of tea. It’s time for our next sessions. One by one, the green lights on the kitchen’s master panel go on, and we file out to retrieve our patients from the waiting room.

Lori Gottlieb is a psychotherapist and New York Times bestselling author who writes the weekly "Dear Therapist" advice column for the Atlantic. A contributing editor for the Atlantic, she also writes for the New York Times Magazine, and is a sought-after expert on relationships, parenting, and hot-button mental health topics in media such as The Today Show, Good Morning America, CBS This Morning, Dr. Phil, CNN, and NPR. She lives in Los Angeles. Learn more at LoriGottlieb.com or by following her @LoriGottlieb1 on Twitter.